"When in the Course of Human Events..."

From the President...

"When in the Course of Human Events..."

Robert R. Urban, MD

Year 1776; Place Philadelphia, Pennsylvania, U.S.A.
Event Drafting of the Declaration of Independence

When the Founding Fathers, a small group of American colonists, gathered to formalize their conviction that the thirteen colonies had had enough of the dictatorial oppression of King George and the British government, it was a lonely gathering. Historians tell us that less than four percent of the colonists were in sympathy with this group on the question of secession. The remainder had no opinion and/or were willing to remain loyal to the King. This latter majority "didn't want to make waves." They preferred to "keep peace in the family." They didn't want to "rock the boat." Yes, they favored the "comfort zone" over standing up for freedom.

Physicians, does that sound familiar? Let's put those thoughts in the context of American medicine today. Membership in the Association of American Physicians and Surgeons is less than four percent of American physicians, who seem to favor the "comfort zone" over freedom in medicine. Taking such a position would require standing up to an oppressive and interfering government, and to our government's stepchild --- managed care.

We celebrate the Fourth of July as a dedication to the Founding Fathers and the untold numbers of American patriots who have fought and died over the last two hundred and twenty-six years so that we would have the right to govern ourselves, to set the rules according to our "unalienable rights." We have forgotten that our government was set up to be a "government of the people, by the people, and for the people." It was so carefully crafted by the framers for the sole purpose of protecting "our rights," deriving its power from the "consent of the governed." In fact, our Constitution goes so far as to say that when government abuses the rights of the people, the people have every right to overthrow that government, "to alter or abolish it."

Where am I going with this? Let's switch scenarios from Philadelphia in 1776 to the medical profession in Smalltown, U.S.A. in 2002. Physicians today are disillusioned, confused, angry, and frightened. They entered the profession as idealists, anxious to make a difference in dealing with the sick and injured, spending their best years (many of them) training to do just that --- helping others in their times of medical need. The profession of medicine was indeed a calling. Then, as our burgeoning government and the insurance companies began their invasion of that formerly noble profession, physicians, who were not naturally politicians or entrepreneurs, began to lose their direction, and incrementally, the erosion of that profession progressed to its current pitiful state. Most medical decisions are now made or strongly influenced by non-medical managers and bureaucrats. The Oath of Hippocrates now is found in various forms, diluted and compromised away from its original words and intent. Physician and patient autonomy no longer exist. Independent private practice is now an aberration. Fear of malpractice claims and false allegations of fraud and abuse are rampant. Confidentiality is now in grave jeopardy. In fact, if the current lawsuit brought by AAPS against the government over the privacy issue fails, private practice in the traditional sense will be lost forever. Few physicians are even aware that come next April, the confidentiality of the patient/doctor relationship will be turned over to the government, law enforcement agencies, and third parties. Very few physicians would now think of encouraging our youth to follow in their footsteps. At a recent AAPS conference, the largely physician audience of one hundred and thirty-two attendees was asked, "How many here would encourage their children to become physicians?" Only two hands were raised.

Maybe it is time for another Philadelphia 1776 type of gathering for freedom; a time for another small minority to be heard --- over the din of those who would trade "freedom in medicine" for the comfort zone. Then perhaps we could look forward to another "Fourth Of July," as a dedication to those who stood up for the reinstitution of that freedom. And I'll be willing to bet dollars to doughnuts that it will be members of the Association of American Physicians and Surgeons who will be standing --- the same ones who have refused to be intimidated by the government and managed care, and who have never waivered from their obligation to the original and true Oath of Hippocrates.

Dr. Urban is the president of the Association of American Physicians and Surgeons, founder and past president of the Society for the Education of Physicians and Patients, and practices medicine in Belle Vernon, Pennsylvania. His e-mail address is [email protected].